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  • 8/12/2019 ARKSEY e OMALLEY (2005) ESTUDOS DE ESCOPO

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    Int. J.

    Social Research Methodology 1 1

    Rout ledge

    Vol.8, No. 1,February2005, pp. 19-32 ^ T . o . .. n c o

    Scoping Studies Towards a

    Methodologica l Framework

    Hilary Arksey Lisa O 'M alle y

    Rec eived 10 September 2002; accepted 11 M arch 2003

    Thispaper focuses onscopingstudies, an a pproach to reviewing the l i terature which to date

    has received l i tt le at tent ion in the resea rch methods l i terature. W e dist inguish between

    different types of scoping studies and indicate whe re these stand in relat ion tofull syste m-

    atic reviews. We outl ine aframework for co nduct ing a scoping study based on o ur recen t

    experiences o freviewingthe l i terature o nservicesfo rcarersfor people with mental health

    problems. Where appropriate, our approach to scoping the f ield is contrasted with the

    procedures fol lowed in systematic reviews. We e mphasize h ow including a co nsultat ion

    exercise in this sort of study may enhance the results, making them more useful to policy

    makers, pract i tioners an dserviceusers. Finally, weconsiderthe advan tages and l imitat ions

    of th e approach andsuggest that a wider debate iscalledfor about the role of th escoping

    study in relat ion to other types of l iterature reviews.

    Introduction

    As the d r ive tow ards evide nce-based pract ice has g a thered pace , increas ing nu m be rs of

    sys temat ic reviews repor t ing on the effec t iveness of t rea tments and procedures have

    been pub l i shed by , f o r exampl e , t h e Cochrane Co l l abo ra t i on , an in t e rna t i ona l body

    suppo r t ed in th e UK by th e UK Cochrane Ce n t r e bas ed in Oxfo rd , and th e NHS C en t r e

    for Reviews and Disseminat ion (CRD) a t the Univers i ty of York. The methodo logy for

    conduct ing fu l l sys t emat ic reviews in the area of hea l th care , educat ion and cr iminal

    Hilary Arksey is Re search Fellow in the Social Policy R esearch Unit at the University o f York, Hesling to n, York

    YOlO 5DD, UK. Tel: +44 (0)1904 321950; Fax: +44 (0)1904 321953; Email: ha4@yo rk.ac.uk. He r rese arch in te r-

    ests includ e informal care , emplo yment and d isabil ity and research metho ds. Her most recent bo ok (co-autho red

    with Peter Knight) isInterviewing forsocialscientists: anintroductory resourcewithexamples(Sage, 1999).

    Lisa O'Malley is a Research Fellow in the Centre for Housing Policy at the University of York, Heslington, York

    YOlO 5DD; UK. Tel: +44 (0)1904 321480; Fax: +44 (0)1904 321481; Email: [email protected]. Her research

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    20 H. Arksey L O'Ma lley

    jus t ice has progressed considerab ly , and gu ide l ines for those conduct ing reviews are

    no w avai lable (CCEPP, 1996; CR D, 2001). Cu rren t ly , t e chnique s are be ing d eve lope d

    within the social pol icy and social care fie ld by organizations such as the Campbel l

    Co l labora t ion , the Evidence for Po l icy and Pract ice Informat ion and Co-ord inat ing

    Ce ntre (EPPI Ce nt re ) , and the ESRC UK Ce ntre for Evide nce Based Po l icy and Pract ice

    (EBPP).

    This rapid groMi:h in und e r taking reviews of the l i t e ra tu re has resu l t e d in a p le tho ra

    of t e rmino lo g y to de scribe appro aches tha t , de spit e the i r d i fferen t name s , share ce r ta in

    essen t ia l character is t ics , namely , co l l ec t ing , evalua t ing and presen t ing the avai lab le

    research e vid ence . The fo l l owing l is ts so me of the labe ls in cu rren t usage : (fu l l ) system -

    atic review; meta-analysis; rapid review; ( tradi t ional) l i terature review; narrat ive

    review; research synthes is ; and s t ruc tured review. There do no t appear to be any

    consis t en t d ef in it ions o f these d i fferen t review 'animals ' , wi th the resu l t tha t research-

    ers may use labels loosely. For instance, there is a risk that reviews defined by their

    au tho rs as ' sys t em at ic ' may no t a ll ad o p t the same high s tand ard s in t e rms of pro t e c t ion

    against bias and the quali ty assessment for the select ion of primary research. On this

    basis the co rrec t labe l wo u ld be ' l it e ra tu re review' and no t ' sys t emat ic review' .

    The ' scoping ' s tudy comprises a fur ther type of l i t e ra ture review, ye t un t i l recen t ly

    mu ch l e ss em phasi s has been p laced o n th e scop ing s t u d y as a t e chn iqu e t o 'ma p ' re l e -

    vant l i t e ra tu re in the f ie ld o f in t eres t . So what mig h t we conside r t o be t he m ain d i ffer-

    ence s betw ee n a system atic review and a scoping s tu d y? Firs t , a systematic review m ight

    typica l ly focus o n a wel l -de f ined qu es t io n where appro pria t e s tu d y des igns can be ide n-

    t i f i ed in advance , whi ls t a scoping s tudy t ends to address broader t opics where many

    differen t s tudy des igns migh t be appl icab le . Second , the sys temat ic review aims to

    provide answers to qu es t io ns from a re la t ive ly narrow range of qual i ty assessed s tud ies ,

    whils t a scoping s tudy is less l ikely to seek to address very specific research quest ions

    nor , consequen t ly , t o assess the qual i ty of inc luded s tud ies .

    It is o u r con t e n t i on tha t g r ea t e r cl a ri ty r eg ard ing th e t e rmino l o g y and m e t ho d s tha t

    surround l i t e ra ture reviews wi l l ass is t researchers in iden t i fy ing when and how such

    reviews migh t be under taken. Whi ls t cr i t ic isms have been l evied a t bo th ' t rad i t ional '

    and ' sys t emat ic ' review methods we con tend tha t there i s no s ing le ' i dea l type ' o f l i t e r-

    a ture review, bu t ra ther tha t a l l l i t e ra ture review methods offer a se t o f t oo ls tha t

    r e s earche rs need t o u s e appropr ia t e ly . To tha t end th e scop ing s t u dy i s one me thod

    amongs t many tha t migh t be used to review l i t e ra ture . Our framework aims to c lar i fy

    when a scop ing s t u dy migh t b e an appropr ia t e me thod t o adop t and how we migh t g o

    abou t u nde r t ak ing th is k ind o f l i t e ra t u r e rev iew.

    To da te , l i t t l e informat ion is avai lab le abou t how to under take a scoping s tudy, as

    thos e scop ing r eviews tha t have bee n co ndu c t ed t end no t t o p ro v id e d e t a il e d in fo rma-

    tion (Hage l l Bo u rke Do wling , 1999; Jepso n, Blasi , W right , R iet , 2001). This pape r

    a t t em p ts t o add res s th e cu r r en t gap in knowled ge abo u t scop ing st u d i e s . Whe re appro -

    p r ia t e , co mpar i so ns a re m ade wi th sys t ema t ic rev iew m e t ho d s . We p ro v id e a mo de l fo r

    those wishing to scope the f i e ld of in t eres t based on our exper iences of scoping

    pub l i shed and u npub l i shed l i t e ra t u r e fo r a s t u d y o f se rvices t o s u ppo r t ca re rs fo r p eo p l e

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    Internat ional Journal o f Socia l Research Methodo logy 21

    The paper is o rganized as fo l l ows. First , we presen t an overview of sco ping s tud ies ,

    con t ras t ing th is approach to reviewing the l i t e ra ture wi th tha t o f sys temat ic reviews.

    We g o on t o o u t l i n e th e d if fe r en t s tag es o f

    framework for a scoping s tudy, inc lud ing

    d i scuss i on o f th e advan tages o f inc l ud ing a consu l t a t i on exe rc i s e . We conc l ud e by

    exp lo r ing s ome o f th e advan tages and l imi t a t i ons o f t h e scop ing s t u dy approach t o

    reviewing the l i t e ra ture .

    W hat is a Scoping Study?

    Definit ions of scoping s tu d ies are few and far be twe en. At a g ene ra l leve l , scoping s tu d -

    i es migh t ' a im to map

    rapidly

    the key concep t s u nd e rp inn ing a re s earch a rea and th e

    main sources and types of evidence avai lab le , and can be under taken as s tand-a lone

    projects in their own right , especial ly where an area is complex or has not been

    reviewe d com prehensive ly before ' (Mays, R o ber ts , Po pay, 2001, p . 194; em phasis in

    or ig inal ) .

    Whi ls t th is def in i t ion draws a t t en t ion to the need for comprehensive coverage

    (b read th ) o f t h e ava i l ab l e l i t e ra t u r e , t h e r e may be qu i t e d i f f e r en t d eg r e es o f d ep th

    (amoun t o f in fo rma t i on ex t rac t ed f rom s t ud i e s and subsequen t ly r epo r t ed ) cove red in

    d i fferen t k inds of scoping s tud y. The e x ten t t o which a scoping s tu d y seeks to provid e

    in -d ep th cove rage o f avail ab l e l it e ra t u r e d epe nds o n th e pu rpos e o f t h e r ev iew itself.It

    is poss ib le t o iden t i fy a t l eas t four common reasons why a scoping s tudy migh t be

    u n d e r t a k e n :

    1. To e xamine the e x ten t , range and natu re of research ac tivi ty: th is type of rapid

    review might not describe research findings in any detai l but is a useful way of

    mapping f ie ld s of s tud y where it is d i ff icu l t t o v isua l ize the rang e o f mater ia l tha t

    might be avai lable.

    2.

    To d e t e rmine the value of und e r taking a fu l l syst em at ic review: in these cases a

    pre l iminary mapping o f th e l i t e ra t u r e migh t b e unde r t aken t o i d en t i fy whe the r o r

    not a fu l l systematic review is feasible (does any l i terature exis t?) or re levant (have

    sys t ema t ic r eviews a l ready been cond u c t ed ?) and th e po t en t i a l cos t s o f co nd u c t ing

    a fu l l syste matic review.

    3.

    To sum marize and d issem inate rese arch find ings : th is k ind of scoping stu d y migh t

    descr ibe in more de ta i l the f ind ings and range of research in par t icu lar areas of

    s tud y, there by provid ing a me chanism for sum marizing and d issem inat ing research

    findings to po l icy makers , prac t i t i oners and consumers who migh t o therwise lack

    t ime o r r e sou rces t o unde r t ake s uch work th emse lves (An tman , Lau , Kupe in ick ,

    Mo s te l l e r , Chalm ers , 1992).

    4.

    To ide n t ify research gaps in the exist ing l i t e ra tu re : this type of scoping s tud y takes

    the process of d issem inat io n o ne s t ep fur ther by d rawing conclu s ions from exis t ing

    l i terature regarding the overal l s tate of research activi ty. Specifical ly designed to

    iden t i fy gaps in the evidence base where no research has been conducted , the s tudy

    may also summarize and disseminate research findings as wel l as identify the re le-

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    22 H. Arksey L O'Ma lley

    t o no t e t ha t i d e n t ifying gaps in th e l i t e ra t u r e t h rou g h a scop ing s t u dy wil l no t n e ces -

    sari ly identify re search g aps whe re th e re search i tse lf

    is

    of po o r qual i ty s ince qu al i ty

    ass es smen t d o e s no t f o rm par t o f t h e scop ing s t u d y r em i t .

    Genera l ly speaking , these four types sugges t two d i fferen t ways of th inking abou t the

    r o l e o r p u rp o s e o f

    scoping s tud y: the f irst two sugg es t tha t the sco ping stu d y migh t be

    perce ived as o ne par t o f an o ng o ing proce ss of reviewing , the u l t imate a im o f which is

    t o p rod u ce a fu l l sys t ema t ic rev iew. The s eco nd two types s ugge s t t ha t t h e scop ing s t u d y

    migh t b e conce ived as a me thod in i t s own r i gh tlead ing t o t h e pub l i ca t i on and

    dissemination of research findings in a part icular fie ld of enqu i ry . The aim of identify-

    ing gaps in the exis ting e vide nce base is c l early impo r tan t , and may or may no t l ead u l t i -

    mately to a fu l l systematic review.

    The r emainde r o f t h i s pape r i s conce rned wi th th e fou r th type o f scop ing s t u dy ,

    a ime d a t id e n t ifying gaps in th e ex is ting r e s earch l i t e ra t u r e . We p res e n t o ne me tho d o -

    log ica l f ramework based on our own experiences of conduct ing th is sor t o f scoping

    s tud y; whe re appropria t e , we ide n t ify how the proce sses we ad o p te d mig h t d iffer f rom

    procedures fo l l owed for a sys temat ic review.

    Methodological Framework

    Ou r framewo rk fo r cond u c t ing a scop ing s t u d y is u nd e rp inned by th e v iew uphe l d by

    propo nen t s o f sys t ema t ic r eviews tha t t he me tho d s u s ed th ro u g ho u t t h e d i ff e ren t s tag es

    are cond u cte d in a r igo rou s and t ranspare n t way (CR D, 2001; Mays e t a l ., 2001). The

    process shou l d be d o cu me n t e d in su f fic ien t d e t a il t o enab l e th e s t u d y t o b e r ep l ica ted

    by others. This explici t approach increases the re l iabi l i ty of the findings, and responds

    to any sugges t ion tha t the s tudy lacks methodo log ica l r igour (Mays e t a l . , 2001).

    The me thod adop t ed fo r i d en t i fy ing l i t e ra t u r e in a scop ing s t u dy needs t o ach i eve

    in -d ep th and b ro ad r e su l t s . R a the r than be ing g u i d e d by a h igh ly focussed r e search

    qu e s t ion tha t l e nds it se l f t o searching for par t icu lar s tu d y de s igns (as mig h t be the case

    in a sys t ema t ic r ev iew) , t h e scop ing s t u dy m e tho d is g u i d ed by a r equ i r eme n t t o i d e n -

    t ify al l re levant l i terature regardless of s tudy design. I t is l ikely that as familiari ty with

    the l i t e ra ture i s increased , researchers wil l want t o red ef ine se arch t e rm s and u nd e r take

    more sens i t ive searches of the l i t e ra ture . To th is end , the researcher may no t wish to

    p lace s t r ic t l imi ta t ions on search t e rms, iden t i f ica t ion of re l evant s tud ies , o r s tudy

    se l ec t ion a t the ou tse t . The process i s no t l inear bu t i t e ra t ive , requi r ing researchers to

    eng age wi th each stage in a ref lexive way and , where necessary, repea t s t eps to ensu re

    tha t the l i t e ra ture i s covered in a comprehensive way.

    With these d i fferences in mind , we now go on to descr ibe the s tages of the frame-

    work we adop t ed fo r conduc t ing a scop ing s t u dy :

    Stage 1 : iden t i fy ing the research ques t ion

    Stage 2 : ide n t ifying re l e vant stu d ies

    Stage 3 : s tudy se l ec t ion

    Stage 4 : char t ing the d a ta

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    Internat ional Journal o f Socia l Research Methodo logy

    23

    An add i t i ona l , para l l e l e l emen t i s a l s o d escr ibed r egard ing th e u s e o f a ' consu l t a t i on

    exercise ' t o inform and val ida te f ind ings from the main scoping review. Whi ls t

    consu l t a t i on migh t b e v i ewed as an op t i ona l componen t o f t h e scop ing s t u dy f rame-

    work, i t g rea t ly enhanced our work, a v iew confi rmed by o ther researchers (Ol iver ,

    2001).

    Framework S tage

    1:

    Identifying theResearch Quest ion

    As wi th sys temat ic reviews, the s tar t ing po in t i s t o iden t ify the research qu es t io n to be

    add ressed as th is gu ides the way tha t search st rat eg ies are bu i l t . Thu s it is impo r tan t t o

    consider which aspects or ' facets ' (CRD, 2001) of the research quest ion are part icularly

    impor t an t , f o r exampl e , t h e s t u dy popu la t i on , in t e rven t i ons o r ou t comes .

    Our research ques t ion was:Wh a t isknown from the exist ing l iterature about the effec-

    t iveness and cost effectiveness o fservices to support carers of people with mental health

    problems?We were aware t ha t ' se rv ices t o s u ppo r t ca re rs ' was an ambigu o u s t e rm tha t

    cou ld inc lude poss ib le benef i t s der iv ing from services d i rec t ed toward care recipien ts ,

    such as day care , for example . We a lso had to de t e rmine what i l lnesses were to be

    inc l ud ed in th e t e rm 'men ta l h ea l th p rob l ems ' .

    Defining these k inds of parameters , and consider ing the impl ica t ions of adop t ing

    par t icu lar pos i t ions , is impo r tan t a t the ou tse t o f a scoping s tu d y. Very wide d ef in it ions

    of what migh t cons t i t u t e services for carers , for example , migh t reduce the l ike l ihood

    o f missing r e l evant a rt ic l e s , bu t co u l d a lso g ene rat e an u nmanage ab ly l arg e nu mb e r o f

    r e fe r ences . Ou r reco mm end a t i on wo u l d be t o main ta in a wide appro ach in o rd e r t o

    g e ne ra t e br ead th o f cove rage . Dec i si ons abou t how t o s e t parame t e rs o n la rg e nu mbe rs

    o f b ib l i og raph ic r e f e r ences can be made once s ome s ense o f t h e vo l ume and g ene ra l

    scope of the fi e ld has bee n g ained .

    Framework

    Stage

    2 :Identifying Relevan t Studies

    As a l ready indica ted , the whole po in t o f scoping the f i e ld i s t o be as comprehensive as

    poss ib le in iden t i fy ing primary s tud ies (pub l ished and unpubl ished) and reviews su i t -

    ab le for answering the ce n t ra l rese arch qu e s t ion . To achieve th is, we ado p te d a st ra t eg y

    that invo lved searching for research evidence via d i fferen t sou rces :

    e l ec t ronic da tabases

    reference l is ts

    hand-s earch ing o f key jo u rna l s

    exis t ing ne tworks , re l evant organiza t ions and conferences

    From a p ract ica l po in t o f view, d e c is ions have t o b e mad e a t t h e o u t s e t abo u t t h e cove r -

    age o f t h e r ev i ew in t e rms o f t ime span and l anguage . Re f l ec t ing t ime and budge t

    cons t ra int s , we inc l ud ed on ly thos e s t u d i e s pub l i shed be twee n Janu ary 1985 and Oc to -

    be r 2001.The s tar t d a t e o f 1985 was chosen because i t was fe l t tha t th is covere d major

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    24 H. Arksey

    L.

    O'Ma l ley

    l anguage mater ia l was excluded because of the cos t and t ime invo lved in t rans la t ing

    mate r ial . Whils t we had t o ad o p t these l imi ts for prac t ica l reaso ns , it is wo r th po in t ing

    o u t t ha t po t e n t ia l ly re l evan t pape rs cou l d have bee n miss ed .

    Electronicdatabases, the Interne t andresearch registers

    Elec t ronic da tabases usua l ly con tain bib l iographic de ta i l s and abs t rac ts of pub l ished

    mat e r i al . There a r e a num be r o f

    issues

    researche rs need t o cons id e r be fo r e u nd e r t ak ing

    this impo r tan t s tage of the process such as : which d a tabases to search; what k inds o f

    re la t ed t e rms migh t be appropria t e t o search for , in add i t ion to key concep ts ; p i lo t ing

    the search s trategy to al low for refinement; whether any technical searching ski l ls are

    avai lable to assis t with the searches; and what the potential costs are of online access to

    e l e c t ronic da tabases , in t er- l ibrary loans and pho to co pying fu l l ar t ic l es tha t are availab le

    local ly.

    The search s t ra t eg y for e l e c t ronic d a tabases is d eve lope d from the research qu es t io n

    and defini t ions of key concepts. Researchers may not have the ski l ls necessary for

    designing and executing sensi t ive search s trategies that qualified l ibrarians have. An

    Inform at ion Officer ' f rom CR D wo rked wi th us to ide n t ify the re l e vant keywo rds

    (which may d i ffer f rom one da tabase to ano ther) ; she a lso advised on what da tabases

    were mo s t l ik e ly t o p rod u ce th e type o f s t u d i e s we were s e ek ing . She th en d ev i sed an

    ini t ial search s trategy, which was later refined in the l ight of early resul ts . The final

    vers ion was f i rs t used on the MEDLINE database and then conver t ed for each subse-

    q u e n t d a t ab ase .

    For ou r s tud y, searches were mad e o n 12 d a tabases available f rom CD -R OM s, and

    four v ia the In te rne t . The re were hug e varia t io ns in the nu m be r of references g ene ra ted

    by each da tabase wi th fou r d a tabases pro d u cing l ess than 10 hi t s each and two

    (MEDLINE and EMBASE) producing 1,565 and

    1 589

    respectively. I t is not known

    how e ffec tive the d ifferen t d a tabases were in g ene ra t ing the 204 art icl es tha t we re e ven-

    tua l ly inclu d ed in the fina l se l ec t ion . Such informat io n cou ld be usefu l for any s imi lar

    work l ik e ly t o b e und e r t ake n in th e fu t u r e .

    Reference l ists

    We fou nd it va luab l e t o check th e b ib l iog raph ies o f s t u d i e s found th rou g h th e da t abase

    searchesespecia l ly sys temat ic reviews and t rad i t ional l i t e ra ture reviewsto ensure

    they had bee n inc lud ed in the scoping e xercise . This process d id ide n t ify fur the r refer-

    ences , a l t hou gh a sa t u ra t i on po in t was r eached where no new ones were be ing i d en t i -

    f ied . Ci ta t ion searches mig h t have also y ie ld ed new stu d ies , a l tho u g h we d id no t u t il ize

    th is t echnique .

    Hand-searching of key journal

    I t is impo r tan t tha t key jou rnals are hand -searched to ide n t ify ar t ic l es tha t have bee n

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    Internat ional Journal o f Socia l Research Method ology 25

    coverage , index ing and d ep th o f in fo rma t i on . A l though mos t da t abases con ta in a

    pro po r t io n of Brit ish jou rnals , they a ll t end to have a We s tern and par t icu lar ly US bias.

    We i d en t i f i e d fou r common j ou rna l t i t l e s t ha t we f e l t r equ i r ed hand-s earch ing .

    Unfor tunate ly , no t a l l o f the journals were avai lab le a t the Univers i ty of York which

    meant t rave l l ing some d is tance to the neares t l ibrary tha t subscribed to the journal (s )

    in que s t io n , an unan t i cipat ed act iv ity tha t add ed t o t h e p res su re o n t ime and r e sou rces .

    Existing ne tworks, relevant organizat ions and conferences

    As o ther researchers under taking reviews have found (Badger , Nurs t en , Wi l l iams,

    Woodward , 2000) , u s ing ex i s t ing knowledge and ne tworks can g ene ra t e in fo rma t i on

    abo u t pr imary rese arch. So , t o o , can con tac t ing re l e vant na t io nal o r l ocal o rganiza t ions

    wo rking in the fi e ld , wi th a v iew to hand -searching l ibrar ies and /o r ide n t ifying u npu b-

    l i shed work . We con tac t ed a number o f r e l evan t o rgan iza t i ons inc l ud ing Care rs UK,

    the Sa insbu ry Cen t r e f o r Men ta l Hea l th , t h e Men ta l Hea l th Founda t i on , t h e King ' s

    Fund, and the Nat ional Schizophrenia Fe l lowship .

    The search can genera te many thousands of b ib l iographic references which then

    need apprai sing t o s e e whe the r o r no t t h ey shou l d be inc l ud ed in th e f inal s t u d y se l ec -

    t ion . Bib l iographic sof tware packages such as Reference Manager or Endno te , and

    genera l t ex t re t r i eval da tabases such as Idea l i s t , are usefu l da ta management t oo ls . We

    used an Endno te l ibrary which proved invaluab le for managing records , keeping t rack

    of ar t ic l es and making reques ts for in t er- l ibrary loans . The Endno te sof tware was

    compat ib le wi th the word process ing package we were us ing , and i t was a re la t ive ly

    quick and easy task to produce l i s t s o f references for inc lus ion in the f ina l l i t e ra ture

    review repor t . The Informat ion Officer recorded each da tabase searched , the years i t

    covered , and the da te i t was searched for each se t o f resu l t s when they were impor t ed

    in t o End no t e . Knowing wha t da t abases were sea rched and f rom wha t da t e i s impo r t an t ,

    especia l ly if the re i s any l ike l ihoo d of having to u pd ate the searches in the fu tu re .

    The var i ous mechan i sms fo r s ea rch ing in ou r scop ing s t u dy g ene ra t ed a t o t a l o f

    3 ,867 references , som e 112 of which were iden t i fi ed as the s tu d y pro gre ssed ( these we re

    t rea t ed in the same way as those genera ted in the main e l ec t ronic b ib l iographic da ta-

    base search) . The major i ty of references (3 ,755) were found on the e l ec t ronic b ib l io-

    g raphic da tabases , which fur the r em phasizes the im po r tance of de ve lo ping skil l s in th is

    area.

    Framework S tage3:StudySelection

    Our in i t ia l perusa l o f the ci ta t ions ind ica ted tha t the search s t ra t egy had picked up a

    l arg e nu mbe r o f ir re l e vant s t u d i e s . Th is hnks t o t h e impo r t ance o f d e f in ing t e rmino l -

    og y at the o u tse t of a sco ping s tu d y, and in o u r case refiects som e specific difficul t ies

    such as d i fferen t coun t ry ' s t e rmino logy to descr ibe carers , and the fac t tha t we had

    sough t b r ead th ra th e r than d ep th .

    We nee d e d a me chan ism t o h e lp u s e l imina t e st u d i e s tha t d i d no t add res s o u r cen t ra l

    research ques t ion . Sys temat ic review methods deve lop inc lus ion and exclus ion cr i t e r ia ,

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    in d ec i s i on -making . Our scop ing s t u dy adop t ed s imi l a r me thods , a l t hough c r i t e r i a

    were d ev is ed post ho c,based o n increas ing fami l iari ty wi th the l i t e ra tu re , tha t we cou ld

    then apply to a l l the ci ta t ions to de t e rmine the i r re l evance . The inc lus ion cr i t e r ia used

    in our scoping s tudy re la t ed to the : type of s tudy; type of in t erven t ion; care recipien t

    g r o u p ; an d car e r g r o u p .

    Two reviewers then appl i ed the inc lus ion and exclus ion cr i t e r ia to a l l the c i ta t ions .

    Copies of the fu l l ar t ic l e were ob tained for those s tud ies tha t appeared to represen t a

    'bes t f i t ' wi th the research ques t ion . I f the re l evance of a s tudy was unclear from the

    abs t rac t , then the fu l l ar t ic l e was o rd e red . A d ead l ine was se t , aft e r w hich i t was agreed

    tha t we wou ld no t inc lude any more s tud ies in the analys is . This i s an impor tan t deci -

    s ion to make whe n t ime is l imi ted , a l thou g h i t is g o o d pract ice to ind ica te in an appe n-

    d ix any ar t ic l es tha t have no t been reviewed bu t which may be of in t eres t t o o ther

    researchers . The nex t s tage requ i res reviewers to re ad t he fu l l ar ticl es t o make the f ina l

    de cis ion abo u t whe the r they shou ld be cho sen for inclu s io n in the review. As Badg er e t

    al .

    (2000) no te , abs t rac ts canno t be assum ed to be repre sen ta t ive o f the fu l l ar t ic l e tha t

    fo l l ows, or t o cap tu re the fu l l sco pe of an art ic l e .

    Out of our or ig inal 3 ,867 references , 453 were ordered through in ter- l ibrary loans;

    som e 30 or so were available l oca l ly for pho to co pying . H aving read the ar t ic l es in fu l l ,

    204 art icles were selected for inclusion in the review.

    Framework S tage

    4:

    Chart ing the Data

    The nex t stage of the wo rk invo lved 'char t ing ' key i t ems of informat io n o b tained from

    the primary research repor ts be ing reviewed . 'Char t ing ' (Ri tchie and Spencer , 1994)

    de scribes a t e chniqu e for synthes izing and in terpre t ing qual i ta t ive da ta by s i ft ing ,

    char t ing and sor t ing mater ia l accord ing to key issues and themes , a s imi lar process to

    th e o ne we ado p t ed hence we have bo r ro we d th e t e rm. In a sys t ema t ic rev iew, thi s p roc-

    ess wou ld be ca l l ed ' da ta ex t rac t ion ' and , in the case of meta-analys is , migh t invo lve

    specific s tat is t ical t e chniqu e s.

    Our chart ing approach was akin to a 'narrat ive review' (Pawson, 2002, p. 171),

    which takes a bro ad e r v iew that can includ e , for example , reco rd ing info rmat io n abo u t

    th e ' p rocess ' o f each p rog ramme o r in t e rven t i on inc l ud ed in th e r ev i ew so tha t i t s

    ' o u t co me ' is con t ex t u a l ized and mo re u nd e rs t and ab l e t o r e ade rs. Dec i si ons have t o be

    t aken abou t wha t in fo rma t i on shou l d be r eco rd ed f rom the p r imary s t ud i e s , and i t i s

    impor t an t t o cons i d e r how compar i sons be tween d i f f e r en t in t e rven t i ons can be

    ach ieved . Simp ly p rod u c ing a sho r t s u mm ary o r p ro f il e o f each s t ud y do es no t g u aran-

    t e e h e lp ing thos e r eade rs who migh t have t o make impor t an t d ec i s i ons based on th e

    s tu d y f ind ings (Pawson, 2002). The ' de scr ip t ive-analy t ica l ' me tho d wi th in the narra-

    t ive t rad i t ion , which invo lves applying a common analy t ica l f ramework to a l l the

    primary research repor ts and co l l ec t ing s tandard informat ion on each s tudy, s tands

    mo re chance o f b e ing u s e fu l .

    The da t a tha t we char t ed were en t e r e d o n t o a ' da t a chart ing fo rm' u s ing th e da t abase

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    in fo rma t i on r e l a t ing t o , f o r ins t ance , t h e s t u dy popu la t i on , t h e type o f in t e rven t i on ,

    o u t c o me meas u r e s emp l o y e d an d t h e s t u d y d e s i g n . W e r e c o r d e d i n f o rma t i o n a s

    fol lows:

    Au tho r (s ), y ear o f pub l i ca t ion , st u d y l oca t i on

    In terve n t ion type , and co mpa rato r ( if

    any);

    dura t i on o f th e in t e rven t i on

    S t ud y popu la t i ons (care r g rou p ; care r ec ip ien t g rou p)

    Aims of the s tud y

    M e t h o d o l o g y

    O u t c o m e m e a su r e s

    Impo r t an t r e su l t s

    Add i t i ona l s t andard ized da t a were ex t rapo la t ed f rom thos e s t u d i e s wi th an economic

    co mpo nen t . Tog e the r , th es e da t a fo rme d th e basis o f t h e analysis .

    We so ug h t a un i fo rm approach t o a l l 204 s t ud i e s inc l ud ed in th e rev iew, a l thou g h in

    pract ice it was of t en imposs ible t o e x t ract a ll the info rmat io n requ i red whe re re search

    repor ts fai l ed to inc lude re l evant mater ia l . As o thers have no ted (Badger e t a l . , 2000),

    d a ta are no t a lways prese n te d in the mo s t accessib le of fo rmats .

    FrameworkStage

    5:

    Collat ing, Summarizing and Report ing the Results

    This s tage o f a scoping s tu d y invo lves co l la t ing , sum marizing and repo r t ing t he re su l t s .

    Again, we can make u sefu l co mpariso ns be twe en t he scoping s tud y and the fu ll sys t em-

    atic review. Whils t the process of col lect ing and reviewing s tudies for a fu l l systematic

    review may requi re researchers to read and review a large number of s tud ies , on ly a

    small percen tag e m ay be inc lu d ed in the f ina l rep o r t . Evide nce or f ind ings from s tud ies

    no t incl ud ed in the f inal rev iew may consequ en t ly r em ain h id d en f rom pub l i ca t i on . In

    con t ras t , the scoping s tudy seeks to presen t an overview of a l l mater ia l reviewed and

    consequen t ly i ssues of how bes t t o presen t th is po ten t ia l ly large body of mater ia l are

    critical.

    Mo reo ver , un l ike a system at ic review the scoping s tu d y d oe s no t seek to ' syn thes ize '

    ev idence or t o aggrega te f ind ings from di fferen t s tud ies . Whi ls t a scoping s tudy wi l l

    n e ed s ome analy tic framewo rk o r th emat i c cons t ruc t i o n in o rd e r t o p r es en t a narra t iv e

    accou n t o f ex is ting l i t e ra t u r e , t h e r e i s no a t t em p t mad e t o p res en t a v iew r eg ard ing th e

    'weigh t ' o f evidence in re la t ion to par t icu lar in t erven t ions or po l ic ies . This i s because

    th e scop ing s t u d y do es no t se ek t o asses s qua l i ty o f ev id e nce and consequ en t ly canno t

    d e t e rmine whe the r part i cu l a r s t u d i e s p rov id e ro bu s t o r g ene ral izabl e f ind ings .

    Hav ing ' char t ed ' i nfo rma t i on f rom s t ud i e s , we were ab le t o p r e s en t o u r nar ra t iv e

    account of findings in two ways. Eirs t , at tent ion was given to basic numerical analysis

    o f th e ex t en t , na t u r e and d i s t r ibu t i on o f th e s t u d i e s inc l ud ed in th e r ev i ew. We

    prod u ced t abl e s and char t s mapping : the d i s t ribu t i o n o f st u d i e s g e og raphica l ly and fo r

    the d i fferen t care recipien t g roups; the range of in t erven t ions inc luded in the review;

    the r e s earch me tho d s ado p t ed and th e me asu res o f e f fec tiv eness u s ed . Th is par t o f t h e

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    H. Arksey

    L.

    O'Mal ley

    r e search m e tho d s and g e og raph ica l l oca t i on . We co u l d v e ry qu ickly g e t a fl avou r o f t h e

    main areas of int e res t , and co nsequ e n t ly where the s igni fican t g aps were .

    Seco nd , the l it e ra ture was o rganized them at ica l ly accord ing to 11 d i fferen t in t erve n-

    t ion types . This was ano the r d i ff icu l t and t ime -co nsu ming ac tivi ty s ince the re was grea t

    d ive rs i ty and / o r ove r l aps among r epo r t s ; d e scr ip t i ons o f s ome in t e rven t i ons were

    insufficient; and authors ' defini t ions did not always appear jus t ifiable or consis tent .

    The in terven t ion type became the pr imary uni t o f analys is and our f ina l l i t e ra ture

    review repo r t was o rganized aro u nd these 11 ca tego r ies (see Arksey, O'Mal l e y ,

    Baldw in, Harris , 2002).

    In d eve lo ping a framewo rk for co l la t ing and su mm arizing resu l t s , the scoping s tud y

    do es force re searchers to pr ior i t ize cer ta in aspects of the l i t e ra tu re . By ad o p t ing an

    approach based on in t e rven t i on type , o u r f ind ings t ended t o s ubsume th eo re t i ca l o r

    concep t ua l pos i t i ons adop t ed by au tho rs . An a l t e rna t iv e approach may have been t o

    base o u r analys is on co mpe t ing the o r i es of carer in t e rven t io ns (such as 'fami ly th erapy '

    or ' cogni t ive behavioura l therapy). To th is ex ten t i t i s crucia l tha t the scoping s tudy

    me thod r e t a ins a c l a r i ty o f r epo r t ing s t ra t egy so tha t t h e r eade r can d e t e rmine any

    po t e n t ia l b ias in r epo r t ing o r r e co mm e nd a t i ons . As wi th any go od qua l i ty r e s earch, t h e

    pos i t ion , o r po ten t ia l b ias , o f any work mus t be iden t i f i ed and po ten t ia l ly subjec t ive

    decis ions regard ing da ta analys is made c l ear .

    Wi th th is in mind , we sou gh t t o p rov id e a cons i st en t approach t o r epo r t ing o u r f ind -

    ings and d eve l oped a ' t emp la t e ' t ha t we app l i ed t o each in t e rven t i on g roup . The

    templa te began wi th a smal l tab le summarizing bas ic character is t ics of a l l the s tud ies

    inc l ud ed in tha t par t icu l a r in t e rven t i on g rou p , and was fo l l owed by co mm e n tary wr i t -

    t en under the fo l l owing nine headings : in t erven t ions ; sample s izes ; par t ic ipants ;

    research methods ; ou tcomes; evidence re la t ing to e ffec t iveness ; economic aspects ; UK

    stud ies ; gaps in the research.

    By applying a consis t en t appro ach to rep o r t ing t he f ind ings we were ab le t o make

    co mpariso ns across in t erve n t ion types ; iden t i fy con t rad ic to ry evide nce reg ard ing

    specif ic in t e rven t io ns ; iden t i fy g aps in the e vide nce base abo u t ind ividu a l in t erve n t ions

    and across in t erve n t io ns as wel l as co nsid e r poss ib le 'new fron t i ers ' (such as the In te r-

    ne t ) . Ofitself the l i t e ra tu re review (Arksey e t a l ., 2002) provid ed a co mpre he nsive and

    tho rough r ev i ew o f ava i l ab l e l i t e ra t u r e and i d en t i f i e d numerous gaps in th e ev i d ence

    base.

    The ide n t i fica t ion of rese arch gaps in o u r s tud y re l i ed o n two m ain so u rces : the l i t e r-

    ature review, which was confined to identifying areas of overal l weakness within the

    f ie l d by compar ing across in t e rven t i on types and s t u d y d e s igns ; and th e consu l t a t i on

    exercise which proved invaluable for identifying current issues facing practi t ioners and

    carers themse lves tha t rem ained u nd e r-rese arched . I t is t o th is f ina l, and o p t io nal , stage

    o f th e f ramework tha t we no w t u rn .

    Framework Optional Stage: Consultat ion Exercise

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    (O live r , 2001) . Indee d , t he r e now ex is ts a Co chrane Co l l abo ra t ion Co nsum er Ne two rk

    tha t inc l ud es ind iv i dua l s and communi ty o rgan iza t i ons wor l dwide . The Ne twork

    suppor t s and d eve l ops consumer par t i c ipa t i on in th e Co l l abo ra t i on , and he lps make

    the informat ion avai lab le t o consumers .

    In th e l i gh t o f o u r expe r iences o f t h e scop ing s t u d y , we wou l d ce r t ainly end o rs e th is

    approach. As indica ted a t the s tar t , in add i t ion to the l i t e ra ture review, the scoping

    s t ud y a ls o inc l ud ed a consu l t a t i on e l e me n t (se e Ne wbro nner Hare , 2002). Th is

    invo lved th r e e g roups o f s t akeho l d e rs : r ep res en ta t iv es f rom na t i ona l s t a t u t o ry and

    vo lun tary bodies ; managers and pract i t i oners from loca l o rganiza t ions ; and 'key

    informant ' carers .

    Co n t r ibu t o rs t o t h e consu l t a t io n p rov id e d add i t io na l r e fe r ences abou t po t e n t ia l

    s tud ies to inc lud e in the review as wel l as va luab le ins igh ts abo u t issue s re la t ing to the

    effect iveness and cost-effect iveness of services that the scoping review alone would not

    have a l er t ed us to . For ins tance , whereas pr imary research repor ts t ended to focus on

    changes in l eve ls of carer burden , s t ress or knowledge as a measure of effec t iveness ,

    co n t r ibu t o rs approached th e concep t in a mo re rou nd ed and ho l i st ic way tha t e nco m-

    passed five re lated dimensions: benefi ts for the carer; benefi ts for the care recipient;

    benef it s for the fami ly as a who le ; the impact of service usage ; and , l ong t e rm o u tco me s

    fo r s oc ie ty . Th is pe rspec t iv e p ro mpt e d th e r e search t eam t o qu es t i on th e p red o minance

    o f th e u s e o f s t andard ou t come measu res . When r epo r t ing th e f ind ings , we sugges t ed

    tha t a l t e rnat ive approaches to de t e rmining the effec t iveness of in t erven t ions a longs ide

    s t an d a r d o u t c o me meas u r e s s h o u l d b e d ev e l o p e d an d ap p l i e d . A l t h o u g h t h i s e l emen t

    o f ou r appro ach t o a scop ing s t u d y may be cons id e r ed an 'o p t i ona l ex t ra ', t h e consu l -

    t a t i on exe rc i s e d i d indeed p rov id e ' add ed va l u e ' t o t h e l i t e ra t u r e r ev i ew.

    ResourceImplicat ions

    Al though scop ing s t u d i e s a r e o f t en l inked t o ' r ap i d ' appra i sa l , i t wou l d be wrong t o

    assume tha t t h i s me thod r ep res en t s e i th e r a ' qu ick ' o r ' cheap ' op t i on . Our r ev i ew

    em plo yed three fu l l - t ime equ ivalen t staff me mbe rs for s ix m o nth s as wel l as the services

    of an informat ion off icer t o conduct l i t e ra ture searches . The cos t impl ica t ions for

    r e t r i ev ing documen t s th rough in t e r - l ib ra ry l oans and th e t ime imp l i ca t i ons tha t g o

    a long wi th th is re t r i eval mean tha t the scoping s tudy shou ld no t be seen as a cheap

    a l t e rna t iv e t o t h e sys t ema t i c r ev i ew, and consequen t ly we wou l d u rg e funde rs and

    researchers to be cau t ious in assuming tha t a scoping s tudy has s igni f ican t ly fewer

    reso u rce impl ica t ions than a system at ic review.

    Discussion and Conclusion

    The scoping s tudy framework we have presen ted in th is paper comprises f ive s tages ,

    toge ther wi th an op t ional consu l ta t ion exercise . I t i s based on our exper iences of , and

    le arning from, u nd e r taking such a s tud y. As we said a t the ou tse t , there is no de f in it ive

    procedu re fo r scop ing th e l i t e ra t u r e , and we a r e no t s ugges t ing tha t t h e f ramework

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    H. Arksey L. O'Ma lley

    in the l i gh t o f com me nts from co l l eag ue s in CR D, it is probably fair t o say tha t o u r

    mo d e l o f cond u c t ing a scop ing s t u d y shared a nu mbe r o f processes assoc ia t ed wi th

    systematic reviews.

    The p roposed f ramework inc l ud es a ro l e f o r k ey s t akeho l d e r g roups , in th e be l i e f

    tha t inc lud ing the pe rspec t ives of o the rs wi th knowle dg e of, and a ves t ed in t eres t in , the

    area u nd e r examina t ion g ives an impo r t an t ad d i t i ona l d ime ns i on t o t h e r ev iewing

    process . The f ramework a l s o r e f l ec t s t h e impor t ance o f t echno l og ica l d eve l opmen t s

    and e xpert is e r equ i r ed t o r e t r ieve and manage d a t a . To tha t ex t en t , s cop ing s t u d y me th -

    ods may r ep res en t a sh i f t i n me thodo l og ica l f ocus away f rom exper t knowledge o f a

    par t icu lar f i e ld associa t ed wi th the t rad i t ional l i t e ra ture review, towards an approach

    that e mphasizes skil l s associa t ed wi th t echnical knowl ed g e .

    A key s t reng th o f the scoping s tu d y is tha t i t can provid e a r igo ro u s and t ranspare n t

    method for mapping areas of research. In a re la t ive ly shor t space of t ime (compared

    with fu l l systematic review), reviewers are in a posi t ion to i l lus trate the fie ld of interes t

    in t e rms of the vo lu me , na tu re and character ist ics of the pr im ary rese arch. This analys is

    in tu rn m akes i t poss ib le t o iden t ify the gaps in the evide nce base , as wel l as su mm ariz-

    ing and d issem inating re search findings. By pre se nting t he re sul ts in an accessible and

    summar ized fo rma t , po l i cy makers , p rac t i t i one rs and consumers a r e b e t t e r p l aced t o

    make effect ive use of the findings.

    I t wo u l d be misl ead ing o f u s no t t o acknowled ge th e l imi t a t io ns o f scop ing s t u d i e s .

    They do no t , for example , appraise the qual i ty of evidence in the pr imary research

    repor ts in any formal sense . The quant i ty of da ta genera ted can be considerab le . This

    can lead to difficul t decisions about how far breadth (covering al l avai lable material) is

    more impor tan t than dep th (provid ing a de ta i l ed analys is and appraisa l o f a smal l er

    nu mbe r o f st u d i e s ). The scop ing s t u d y do es no t add res s th e i ssu e o f 'syn thes i s ', t ha t is

    the re la tive we igh t o f evide nce in favour of the e ffec t iveness of any par t icu lar in t erve n-

    t ion . Consequen t ly , scoping s tud ies provide a narra t ive or descr ip t ive accoun t of avai l -

    ab le research. Many of these d i ff icu l t i es are addressed by sys temat ic review methods

    tha t d o r equ i r e qua l i ty appra i sa l , t h e r eby (mos t ly ) r educ ing th e quan t i ty o f s t u d i e s

    included in the review and p lacing an emphasis on synthes izing da ta . However , the

    system at ic review proce ss can be very l eng thy, a key d isadvantag e when po l icy make rs

    want informat ion abou t exis t ing research evidence sooner ra ther than la t er .

    I t wou l d be wrong t o v i ew the scop ing s t u dy me thod as an easy op t i on s imp ly

    becaus e hard que s t io ns abou t qu a l ity appra isal and syn thes is ar e avo i d e d . Co nd u c t ing

    a scoping s tudy requi res reviewers to have high degrees of analy t ic ski l l in order t o

    d eve l op f rameworks th rough which l a rg e numbers o f s t u d i e s can be d escr ibed .

    Eur th e rmore , by no t add res s ing i s su es o f qua l i ty appra i sa l , t h e scop ing s t u dy po t en -

    t i a l l y has t o d ea l wi th a g r ea t e r range o f s t u dy d es i gns and me thodo l og i e s than th e

    sys temat ic review, which has t ended to focus on the randomized con t ro l t r ia l as the

    go l d s t andard o f r e s earch d es i gn (CRD, 2001) . A l though e f fo r t s a r e b e ing made t o

    deve lop t echniques for the appraisa l and synthes is of qual i ta t ive da ta wi th in the

    sys temat ic review communi ty (see , for example , Dixon-Woods , Ei tzpat r ick ,

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    Internat ional Journal o f Socia l Research Methodology

    3

    same t ime the scoping s tudy does no t o ffer any c lear means of synthes izing f ind ings

    from di fferen t k inds of s tudy des ign . These i ssues requi re fur ther a t t en t ion i f scoping

    s tud ies are t o deve lop and have a fu ture in advancing the evidence base in hea l th and

    social care.

    One o f th e pu rpos es o f t h e p res en t pape r is t o s t imu la t e d i scuss ion abou t t h e me r it s

    o f scop ing s t u d i e s , and he lp d eve l op appropr ia t e me thods fo r conduc t ing s uch

    reviews. An addi t ional a im for th is paper i s t o provide the s tar t ing poin t for a wider

    d eba t e abou t t h e ro l e o f t h e scop ing s t u dy in r e l a t i on t o o th e r types o f l i t e ra t u r e

    r ev i ews : where do es one end and th e o th e r s t a r t ? We l ook fo rward t o s e e ing how the

    d eba t e p rog res s es .

    Acknowledgements

    This paper is based on a s tud y funde d by a g ran t f rom the UK NH S Service De l ivery

    Organ izat i on (SDO) R es earch and Deve l o pme n t Pro g ramm e. The v iews expres sed

    are thos e o f th e au tho rs and no t n ecessarily shared by any ind ivi du a l , g o ve rnm en t o r

    agency. We wish to thank our co l l eagues on th is pro jec t : Sal ly Baldwin (Depar tment

    of Social Policy and Social W o rk, Universi ty of Yo rk) and Je nnifer H arris (SPR U,

    Univers i ty of York); Anne Mason (Cent re for Heal th Economics , Univers i ty of

    York);

    Su Golder (NHS Centre for Reviews and Disseminat ion , Univers i ty of York);

    El izabe th Newbronner and Phi l ippa Hare (Acton.Shapiro) . Sal ly Baldwin d ied t rag i -

    cal ly in October

    2003.

    Sal ly was a key member of the research t eam, and we grea t ly

    valued her inpu t t o the pro jec t and th is ar t ic l e . We are gra t efu l t o Ju l i e Glanvi l l e ,

    Su Go l d e r , Rache l Pe t o , Gil l R i t chi e , Mark R od ge rs, Amand a Sowd en , A l is on

    Wal lace and Kath Wrigh t for comments on an ear l i e r d raf t o f th is paper . We wou ld

    a l s o l ik e t o acknowledge th e r e f e r e es ' commen t s which have been inco rpo ra t ed in t o

    th e paper .

    Note

    [1] We wou ld l ike to acknowledg e Su Gold er 's valuable su ppor t and co ntr ibut io n to the scoping

    s tudy.

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